ENG20160511.pdfRECEIVED
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT AP.PUCATION
111MIIIC:T NAME': 106318158
CONTACT: Sue Sidick
CONTRACTOR: PSE/Infrasourc I'11011c fl: 425-457-6353
Mailing Address: 1660 Park Lane, Burlington, WA 98233 Fax fl:
..... - --.�
State License #l: INFRA SL.BT 1 C:2 F rnait #: Susan. Sidick r@pse.com
City 13tisiness License #: NR -019840 [_] Liability Insui-ance —1 Bonded
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ADDRESS Olt INTERSEC'I1C7N OF CONSTRUCTION: UCTION: 9014 220th ST SW
[ROW WORK ASSOCIATED I" 'IJ THE FOLLOWING TYPE OF PROJECT -
1-7
Commercial ❑ Subdivision ❑ City I'To.jeet ❑ Ti-aflrc Control (Only)
❑ Midti-Family A Single Family ❑ Other
❑ FUC (I1LA), VIIZIZON, PS ?,,
C ONICA51, OYWSD):
Is this permit Dart of a blanket permit? ❑ Yes [*1 No
ANY ASSOC IA ('I: D PE M1
DESCR:I PTION OF PROPOSED WORTS (Be Specific) : Work area is approx Un c/I of 220th ST SW &
380' E c/I of 92nd AVE W. To Install gas service to 9014 2217th ST SW 1 3x5 paving cut anticipated
AS S`I"
1Zl Ii I' Ci�TI IZl A5'l I�T1I7IIIN THE LAST FIVE () YEARS? YES [I No ❑ Yeat•:106
I'AV P'M FN'I�' C't1 T: i��') Yes ❑Ido If ycs, indicate size of e apt: 3 X5
CONCRETE CUT: 0 Yes ❑ No If yes, indicate size of cut: ------X—
RIGHT-OF-WAY
AREATOTAL
CLOSURE
Sidewalk 48 Hrs + LF XJLF
SF
Alley 72 Hrs t LF X SF
Parking 72 Hrs 4- LF X SF
DURATION
(NUMBER OF MONTHS)
APPLICANT TO READ AND SIGN
*Traffic control and public safety shall be in accordance with City regulations as required by the City
Engineer. Every flagger must be trained as required by (WAC) 296-155-305 and must have certification
verifying completion of the required training in their possession.
*Restoration is to be in accordance with City codes and Standards. All street -cut trench work shall be
patched with asphalt or City approved material prior to the end of the workday -- NO EXCEPTIONS.
Indemnity: The Applicant has signed an application which states he/she hold the City of
Edmonds harmless from injuries, damages or claims of any kind or description
whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departments or employees, including defense costs and attorney fees by reason
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the permit to be valid.
p9 tmYy�n.^ 4�Sus+n SNrk
Susan Sidick °� $L1� °°yb«�E�.4,.a_s'�'� 12/12/2016
SIGNATURE P.��.e,N..,,, :���9,e�,. DATE
1 u,,m: zois m �o orszao orw�
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
W20-1
ROAD
WORK
AHEAD
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...........
Job #:
106318158
Date:
11122116
Jurisdiction:
Edmonds
Right of Way Permit?
F] YES El NO
Est. Start Date:
12/07/16
Est. Duration:
8 Hours
Address:
9014 220TH ST SW
City / Zip:
EDMONI)5 98026
Customer:
BOB HARRISON 206-604-7180
PM / Insp:
Two Hays 747775M
PHONE NUMBER
Construction Method
WORK DESCRIPTION:
MS TALL 23'OF 1-118 " PE SCA T 5 TUB AND 35'OF 1-118 PE SCAT EXT SET A 425 MSA Open Trench Ej
OIL IF Trenchless
UM =
0 =FIRE HYDRANT (120' From tie in)
STORM DRAIN
= ELECTRIC POWER POLE
EMMMESMSMSEMMM33332aa = FENCE 220TH ST SW
CL CL
2" MPE VS S — — — — -- — — — — — — — — — — — — — — — — — S
109013970-2005
19CPA 41
A-,
CX,
SIDEWALK
MEMMIEEMEM 0
PL PL
3:
Uj 17T06
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(11 t. A rZ �7' C A) (v
P'Ot'-f JANito IA.j1Q A 01)0mPA00 Ot- 5o' t109-I?OA) lAt, A- 1`
5 j5 P A ()-A "I i O/J PaW-1 (A'T p,
Surface
'EX
of CIL ___ ___92ND_AYE_W_.__
ASPHALT
'N S of
CIL
'E W
of CIL
'N S of CIL
'E W
of CL
F1
FLAGGERS #
MPH
[j TROLLY LINES
❑ BUS STOP #
❑ METER HOODS #
❑
OFFICERS #
SPEED LIMIT
❑ TRAFFIC SIGNAL
❑ ARTERIAL
❑ NO PARKS #
❑
Commercial
❑ Altered commercial
❑ Leak Repair
Service Information
❑ Template Bar
Residential
E]
Altered Residential
E] CP Work
Diameter Meter
EFV
❑ Bollards 2.5" #
E]
Multi -Family
❑
Replacement Service
0 Pothole
El 5/8,, El 250
❑
1800 Bollards 4" #
❑
El
New Constr.
❑
Main Maintenance
E] Extension
R] 11/8" [D425
2600
Stub
❑
service maintenance
Ej 11/4" E] 630
F1
10,000 ❑ FUEL LINE PERMIT NEEDED
Extension
❑
Valve Maintenance
n 2" El 1000
Fuel Line Length:
El
Compete Sery
❑
Cut & Cap
Mtr Loc: Q/L/F
Fuel Line Diameter: